modelli’alimentari’ -...

Modelli alimentari Franca Marangoni NFI – Nutri0on Founda0on of Italy

BMI adults % pre-‐obese (25.0-‐29.99)

32,4%

© Copyright World Health Organiza0on (WHO), 2012. All Rights Reserved

≤90 91-‐95 96-‐101 102-‐107 ≥108

(mg/dL)

16 yrs

5 yrs

An ongoing process...

OECD Life expectancy at birth

Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute

Cause delle malattie croniche

Saturi

Sana alimentazione: composizione della dieta Proteine

Grassi Carboidra= Monoinsaturi

Polinsaturi

Zuccheri

Omega-‐3

Omega-‐6

Fibra

Acqua

Energy intake from the NHANES data and sales of domestic machines versus obesity rates in the US.

Levine JA et al, ATVB 2006

Sana alimentazione: le nuove linee guida Bilancia i nutrien= e man=eni il peso 1.   Controlla il peso e man=eni= sempre aKvo

2.   Consigli speciali per persone speciali

Scegli la sicurezza e la sostenibilità

Più è meglio 1.   FruPa e verdura 2.   Cereali integrali e legumi 3.   Acqua

Meno è meglio 1.   Grassi 2.   Zuccheri 3.   Sale 4.   Alcol

1.   Varia spesso le tue scelte a tavola 2.   Fai aPenzione alle diete e agli integratori 3.   La sicurezza dei tuoi cibi dipende anche da te 4.   Scegli gli alimen= sostenibili (dal punto di vista

ambientale, economico, sociale, …)

Modificato da: CREA – Le nuove linee guida

Overview of the average daily composi=on and intakes of protein, fat, carbohydrates and alcohol as a percentage of total energy intake (E%) for the New Nordic Diet (NND), the

recommended intake according to the Nordic Nutri=on Recommenda=ons (NNR) and the average composi=on of the diet in the Danish popula=on

C Mithril et al. Public Health Nutri0on 2013; 16(5): 777–785

C Mithril et al. Public Health Nutri0on 2013; 16(5): 777–785

Overview of the average daily content of the dietary components in the New Nordic Diet (NND) in rela=on to the Danish Foodbased Dietary Guidelines (DFDG) and the

average daily content in the Danish popula=on

Tradi=onal Okinawan diet food pyramid

DG Willcox et al. Mech Ageing Dev. 2014; 136-‐137: 148–162

Dietary PaPerns of Japanese Diets


Major Nutrient Tradi=onal Okinawa Okinawan Elder’s Diet Modern Okinawa

Carbohydrate (% kcal) 85% 58% 58%

Protein (% kcal)* 9% 16% 15%

Fat (% kcal)* 6% 26% 28%

Sat. Fat (% kcal) 2% 7% 7%

Cholesterol (mg/1000 kcal) -‐-‐ 156 mg 164 mg

Sodium (mg/d) 1113 mg 3100 mg 3256 mg

Potassium (mg/d) 5199 mg 1999 mg 1901 mg

Food Group Intake in Tradi=onal Diets of Okinawans and Other Japanese

Okinawa, 1949 Japan, 1950

Food Group Weight in grams (% total calories) Grains 192 (33) 481 (75) Nuts, Seeds <1 (<1) <1 (<1) Sugars 3 (<1) 8 (1) Oils 3 (2) 3 (1) Legumes (e.g., soy and other beans) 71 (5) 55 (4)

Fish 15 (1) 62 (5) Meat (incl. poultry) 3 (<1) 11 (<1) Eggs 1 (<1) 7 (<1) Dairy <1 (<1) 8 (<1) Vegetables 965 (58) 301 (8) Fruit <1 (<1) 44 (1) Pickled Vegetables 0 (0) 35 (1)


History of die0ng over 0me including the most popular fad diets

Macronutrient profiles of popular diets, the OmniHeart and Dietary Approaches to Stop Hypertension (DASH) study diets, the American Heart Associa=on Therapeu=c Lifestyle (AHA TLC) guidelines, and typical US macronutrient intakes as reported in the third Health and Nutri=on Examina=on Survey (NHANES III).

JR de Souza et al. Am J Clin Nutr. 2008 Jul;88(1):1-‐11.

Comparison of the calculated macronutrient profiles (mean ± SEM) of various diet plans with the Ins=tute of Medicine's Acceptable Macronutrient Distribu=on Ranges (AMDR). Solid horizontal lines represent the upper and lower limits of the AMDR for the macronutrient. ■, exceeds the AMDR; ■, meets the AMDR; □, failed to reach the minimum AMDR.


Typical faPy acid profiles of popular diets and typical US macronutrient intakes as reported in the third Health and Nutri=on Examina=on Survey (NHANES III) as “reference points.” Solid horizontal line represents the 7% upper level of intake for saturated fat proposed by the AHA.


La dieta Ornish •  E’ sostanzialmente una dieta

egetariana •  E’ molto restridva •  Iperglucidica (70%En da

carboidra0, non semplici) e ipolipidica (10% En)

•  Non implica restrizione calorica •  Viene associata ad advità fisica

regolare e alla riduzione dello stress

•  Non è indicata per alcune condizioni par0colari (età pediatrica, gravidanza, allahamento, anziano)

Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of CHD

Li J et al, JACC 2015

-‐25% -‐15%

-‐9%

The Atkins diet P/C/F = 29/9/62

1.  Your body makes less insulin, and it is thus less probable to develop low blood sugar (hypoglicemia) aoer the meal, and to become hungry .

2.  The body uses fat (instead of glucose) for energy produc0on 3.   Less blood sugar is converted into fat

Eventually, body weight decreases

Why is it important to keep the Glycemic Response low?

Are there other ways to keep the Glycemic Response low? Yes

If you select the proper carbohydrates, you will have, like in the low carb diets, a low glycemic response

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005105.

LOWERING THE GLYCAEMIC LOAD OF THE DIET APPEARS TO BE AN EFFECTIVE METHOD OF PROMOTING WEIGHT LOSS AND IMPROVING LIPID PROFILES AND CAN BE SIMPLY INCORPORATED INTO A PERSON'S LIFESTYLE.

GLYCEMIC RESPONSE AFTER A WHITE BREAD OR A SPAGHETTI MEAL

Ludwig, J Am Med Assoc, 2002-25

0

25

50

0 20 30 40 50 60 90 105 120 150 180

White Bread Spaghetti

Time, minutes

∆ Glic., mg/dL

L’analisi al microscopio elettronico a scansione dimostra che gli gnocchi hanno una struttura compatta come altri alimenti a base di carboidrati a basso indice glicemico. Al contrario negli alimenti lievitati l’elevata porosità conseguente all’incorporazione di gas che espande durante la cottura, aumenta enormemente la superficie esposta all’attività enzimatica.

Riccardi, Nutrition Reviews, 2003

Indice Glicemico (IG), relativo al Pane Bianco, di alcuni alimenti

Alimento Indice Glicemico

Pane bianco 100 Pomodori 13 Ciliegie 32 Fagioli 40/60 Mele 52 SpagheK 52 Maccheroni 68 Pizza 86 Saccarosio 92 Polenta 106 Patate bollite 120 Glucosio 138

Indice glicemico di alcuni alimenti assunti singolarmente o con pasti composti

Association between 4-y changes in servings of protein foods with long-term weight change.

Jessica D Smith et al. Am J Clin Nutr 2015;101:1216-1224

Proteine da fonti “magre” e carboidrati a basso indice g l i cemico promuovono e mantengono nel tempo un miglior controllo ponderale

with the risk of becoming overweight or obese. No associa-tion was observed for dietary fiber intake. Moreover, wefound no significant associations of fruit and dietary fiberintake with weight gain, whereas higher vegetable intakewas associated with greater weight gain during 15.9 y offollow-up.

Although several observation studies (38–44) have investi-gated how different food patterns are associated with weightgain and risk of becoming overweight or obese, few havespecifically investigated the impact of fruit and vegetable intake(16–19). In the European Prospective Investigation into Cancerand Nutrition Study, fruit and vegetable intake was notassociated with weight change during a mean of 5 y of follow-up in 373,803 women and men aged between 25 and 70 y (17).However, in stratified analyses, an inverse association wasobserved between high fruit intake and weight change amongwomen who were initially aged >50 y, of normal weight, neversmokers, or had a low prudent dietary pattern score. The Nurses!Health Study examined 74,063 women followed for 12 y (16),comparing women with the largest increase vs. decrease in fruitand vegetable intake, and the RR of becoming obese was 0.76(95% CI: 0.69, 0.86; P-trend: <0.0001). In 79,236 women andmen of the Cancer Prevention Study II, higher vegetableconsumption was associated with lower odds of gaining weightover a 10-y period (18).

Randomized trials testing diets high in fruits and vegeta-bles—typically among overweight or obese individuals—havebeen linked with weight loss in primary and secondary analyses(20–25). Two randomized trials, one including 45 women (21)and the other 90 women and men (20), have investigated theeffect of fruit and vegetable intake on weight loss as theprimary endpoint. In these 2 trials, following the participantsfor a 10-wk and 8-wk period, respectively, nonsignificantdecreases in body weight were reported for the groups withdiets higher in fruits and vegetables (20, 21). In a trial of 658overweight or obese women and men followed for 6 mo,increasing intakes of fruit, vegetables, fiber, vitamins, andminerals reduced body weight by 5.1–6.1 kg (23). Anotherrandomized trial of 97 obese women reduced the energydensity of the diet through increased intake of fruits andvegetables and decreased fat intake, and the diet interventionresulted in both weight loss and maintenance (24). In a smallrandomized trial of 49 women and men, adding apples andpears but not oats reduced weight by 0.93 kg and 0.84 kg,respectively, during a 10-wk period (25).

Fruits and vegetables may prevent weight gain throughseveral mechanisms. Micronutrients, e.g., potassium andmagnesium, and calcium seem to be beneficial in weightcontrol (45). Polyphenols, a group of bioactive compoundsfound in fruits and vegetables, may prevent weight gain

TABLE 3 HRs (95% CIs) of becoming overweight or obese according to quintiles of fruit, vegetable, anddietary fiber intake among middle-aged and older women1

n Cases

Age adjusted Multivariable adjusted

HR (95% CI) HR (95% CI)2 HR (95% CI)2 + BMI

Fruits and vegetables, servings/dQ1: ,3.5 3573 1726 1.00 (ref) 1.00 (ref) 1.00 (ref)Q2: 3.5 to ,4.9 3680 1705 0.96 (0.90, 1.03) 0.99 (0.93, 1.06) 0.88 (0.82, 0.94)Q3: 4.9 to ,6.3 3672 1600 0.91 (0.85, 0.97) 0.95 (0.89, 1.03) 0.92 (0.86, 0.99)Q4: 6.3 to ,8.2 3668 1577 0.91 (0.85, 0.98) 0.98 (0.91, 1.05) 0.93 (0.86, 1.00)Q5: $8.2 3553 1517 0.91 (0.85, 0.97) 1.01 (0.93, 1.10) 0.91 (0.84, 0.99)P-trend 0.003 0.80 0.19

Fruits, servings/dQ1: ,1.0 3604 1781 1.00 (ref) 1.00 (ref) 1.00 (ref)Q2: 1.0 to ,1.7 3644 1694 0.94 (0.88, 1.01) 0.97 (0.91, 1.04) 0.86 (0.80, 0.92)Q3: 1.7 to ,2.3 3654 1648 0.92 (0.86, 0.98) 0.96 (0.89, 1.02) 0.93 (0.87, 1.00)Q4: 2.3 to ,3.1 3677 1586 0.88 (0.82, 0.94) 0.92 (0.86, 0.99) 0.92 (0.85, 0.99)Q5: $3.1 3567 1416 0.81 (0.75, 0.87) 0.86 (0.79, 0.93) 0.87 (0.80, 0.94)P-trend ,0.0001 0.0001 0.01

Vegetables, servings/dQ1: ,2.0 3605 1659 1.00 (ref) 1.00 (ref) 1.00 (ref)Q2: 2.0 to ,3.0 3649 1617 0.95 (0.89, 1.02) 0.98 (0.91, 1.05) 0.86 (0.80, 0.92)Q3: 3.0 to ,3.9 3682 1674 1.01 (0.94, 1.08) 1.07 (1.00, 1.15) 1.05 (0.97, 1.12)Q4: 3.9 to ,5.4 3662 1618 0.98 (0.91, 1.05) 1.06 (0.98, 1.14) 1.00 (0.93, 1.07)Q5: $5.4 3548 1557 0.99 (0.92, 1.06) 1.11 (1.03, 1.20) 0.99 (0.91, 1.07)P-trend 0.94 0.003 0.22

Dietary fiber, mg/dQ1: ,12.4 3630 1727 1.00 (ref) 1.00 (ref) 1.00 (ref)Q2: 12.4 to ,16.1 3615 1660 0.98 (0.91, 1.04) 1.00 (0.93, 1.07) 1.18 (1.10, 1.27)Q3: 16.1 to ,19.7 3642 1627 0.94 (0.88, 1.00) 0.97 (0.90, 1.04) 1.07 (0.99, 1.16)Q4: 19.7 to ,24.7 3629 1587 0.93 (0.87, 1.00) 0.98 (0.90, 1.06) 1.05 (0.96, 1.14)Q5: $24.7 3630 1524 0.90 (0.84, 0.96) 0.96 (0.88, 1.06) 1.00 (0.91, 1.10)P-trend 0.0008 0.40 0.13

1 All statistical tests were conducted with use of Cox proportional hazards regression models. Q, quintile; ref, reference.2 Adjusted for age, randomization treatment assignment, physical activity, history of hypercholesterolemia or hypertension, smoking status,

postmenopausal status, postmenopausal hormone use, alcohol use, multivitamin use, and energy intake.

Fruits, vegetables, and dietary fiber and weight 5 of 9

at UNIV. DEGLI STUDI-M

ILANO FAC. DI M

EDICINA VETERINARIA on February 27, 2015jn.nutrition.org

Downloaded from

Fruit, vegetables and fiber and risk to develop overweight or obesity.

The Women Health Study.

Rautianien S et al, J Nutr 2015

Fiber intake and PCR in 4.900 USA adults (NAHNES 99-00)

From a fiber intake < 8,4 g/die to an intake > 19,5 g/die, CRP decreases from 2,3 to 1,8 mg/L ( - 20%; p<0,05)

King D, Am J Cardiol 2003

Leading Anti-Inflammatory Nutrition Since 1995

Schema of Poten=al Dose Responses and Time Courses for Altering Clinical Events

of Physiologic Effects of Fish or Fish Oil Intake

Mozaffarian & Rimm, JAMA 2006

Inflammatory Markers and Daily Fish Consumption in 1,514 men (18 - 87 years)and 1,528 women (18 - 89 years) from the ATTICA study

A Zampelas et al; J Am Coll Cardiol 2005; 46:120–4

Participants (%) CRP (mg/L) IL-6 (ng/L) TNF-alfa (mg/dL) Amyloid A (mg/dL) WBC (.000)

No fish

Reinders I et al., Eur J Clin Nutr 2012

CRP concentration and plasma omega-3 quartiles in 1,400 Finnish men

Effect of Dietary Linoleic Acid on Markers ofInflammation in Healthy Persons: A SystematicReview of Randomized Controlled TrialsGuy H. Johnson, PhD; Kevin Fritsche, PhD

THE EFFECTS OF DIETARY LIPIDS ON CARDIOVASCULARdisease (CVD) and other chronic health conditions havelong been an important consideration in thedevelopment of dietary guidelines in the United States

and other countries. The 2010 Dietary Guidelines for Ameri-cans1 recommend that monounsaturated and polyunsatu-rated (PUFA) fats be substituted for saturated fats in diets.There is currently much consistency among recommenda-tions from government and professional organizations thatboth n-6 and n-3 classes of PUFAs are desirable, and that lino-leic acid (LA) as well as !-linolenic acid (ALA) consumptionshould be encouraged as a replacement for SFAs, trans-fattyacids, and (in some cases) refined carbohydrates. For exam-

ple, a recent American Heart Association Science Advisory2

recommended that n-6 PUFAs comprise at least 5% to 10% oftotal energy. The recommended intake for n-6 PUFA (primar-ily LA) in the United States according to the National Heart,Lung, and Blood Institute of the National Institutes of Health3;the Institute of Medicine4; and the 2005 Dietary Guidelinesfor Americans5 ranges from 5% to 10% of energy. Similarly, acurrent Position Statement from the Academy of Nutritionand Dietetics (formerly the American Dietetic Association)and Dietitians of Canada6 noted that intakes for n-6 PUFAshould range from 3% to 10% of energy.

Despite the consistency of favorable recommendations re-garding dietary LA, the possibility that this fatty acid contrib-utes to excess inflammation has received considerable atten-tion. The primary basis of concern is that large amounts of LAwill prompt excessive formation of arachidonic acid (AA) andsubsequent synthesis of pro-inflammatory eicosanoids (eg,prostaglandin E2 [PGE2], leukotriene B4, and thromboxane A2[TXA2]).7-10 Elevated proinflammatory eicosanoid generationcould drive up other biomarkers of inflammation (eg, inter-leukin-6 [IL-6], tumor necrosis factor-! [TNF-!], and C-reac-

ABSTRACTThe majority of evidence suggests that n-6 polyunsaturated fatty acids, including lino-leic acid (LA), reduce the risk of cardiovascular disease as reflected by current dietaryrecommendations. However, concern has been expressed that a high intake of dietaryn-6 polyunsaturated fatty acid contributes to excess chronic inflammation, primarily byprompting the synthesis of proinflammatory eicosanoids derived from arachidonic acidand/or inhibiting the synthesis of anti-inflammatory eicosanoids fromeicosapentaenoicand/or docosahexaenoic acids. A systematic review of randomized controlled trials thatpermitted the assessment of dietary LA on biologic markers of chronic inflammationamong healthy noninfant populations was conducted to examine this concern. A searchof the English- and non–English-language literature usingMEDLINE, the Cochrane Con-trolled Trials Register, and EMBASE was conducted to identify relevant articles. Fifteenstudies (eight parallel and seven crossover) met inclusion criteria. None of the studiesreported significant findings for a wide variety of inflammatory markers, including C-reactive protein, fibrinogen, plasminogen activator inhibitor type 1, cytokines, solublevascular adhesion molecules, or tumor necrosis factor-!. The only significant outcomemeasures reported for higher LA intakes were greater excretion of prostaglandin E2 andlower excretion of 2,3-dinor-thromboxane B2 in one study and higher excretion of tet-ranorprostanedioic acid in another. However, the authors of those studies both observedthat these effects were not an indication of increased inflammation. We conclude thatvirtually no evidence is available from randomized, controlled intervention studiesamonghealthy, noninfant humanbeings to show that addition of LA to the diet increasesthe concentration of inflammatory markers.J Acad Nutr Diet. 2012;112:1029-1041.

ARTICLE INFORMATION

Article history:Accepted 23 March 2012

Keywords:Linoleic acidn-6 fatty acidsInflammationC-reactive protein

Copyright © 2012 by the Academy of Nutritionand Dietetics.2212-2672/$36.00doi: 10.1016/j.jand.2012.03.029

Meets Learning Need Codes 4000, 5000, 5160, 9000, and 9020. To take theContinuing Professional Education quiz for this article, log in towww.eatright.org, click the “MyProfile” link under your name at the top of thehomepage, select “Journal Quiz” from the menu on your myAcademy page,click “Journal Article Quiz” on the next page, and then click the “AdditionalJournal CPE Articles” button to view a list of available quizzes, from whichyou may select the quiz for this article.

RESEARCHReview

© 2012 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 1029

1394 pubblicazioni ! 15 lavori selezionati

Johnson GH et al, J Acad Nutr Diet, 2012

We conclude that virtually no evidence is available from randomized, controlled intervention studies

among healthy, noninfant human beings to show that addition of LA to the diet

increases the concentration of inflammatory markers.

Effect of Dietary Linoleic Acid on Markers ofInflammation in Healthy Persons: A SystematicReview of Randomized Controlled TrialsGuy H. Johnson, PhD; Kevin Fritsche, PhD

THE EFFECTS OF DIETARY LIPIDS ON CARDIOVASCULARdisease (CVD) and other chronic health conditions havelong been an important consideration in thedevelopment of dietary guidelines in the United States

and other countries. The 2010 Dietary Guidelines for Ameri-cans1 recommend that monounsaturated and polyunsatu-rated (PUFA) fats be substituted for saturated fats in diets.There is currently much consistency among recommenda-tions from government and professional organizations thatboth n-6 and n-3 classes of PUFAs are desirable, and that lino-leic acid (LA) as well as !-linolenic acid (ALA) consumptionshould be encouraged as a replacement for SFAs, trans-fattyacids, and (in some cases) refined carbohydrates. For exam-

ple, a recent American Heart Association Science Advisory2

recommended that n-6 PUFAs comprise at least 5% to 10% oftotal energy. The recommended intake for n-6 PUFA (primar-ily LA) in the United States according to the National Heart,Lung, and Blood Institute of the National Institutes of Health3;the Institute of Medicine4; and the 2005 Dietary Guidelinesfor Americans5 ranges from 5% to 10% of energy. Similarly, acurrent Position Statement from the Academy of Nutritionand Dietetics (formerly the American Dietetic Association)and Dietitians of Canada6 noted that intakes for n-6 PUFAshould range from 3% to 10% of energy.

Despite the consistency of favorable recommendations re-garding dietary LA, the possibility that this fatty acid contrib-utes to excess inflammation has received considerable atten-tion. The primary basis of concern is that large amounts of LAwill prompt excessive formation of arachidonic acid (AA) andsubsequent synthesis of pro-inflammatory eicosanoids (eg,prostaglandin E2 [PGE2], leukotriene B4, and thromboxane A2[TXA2]).7-10 Elevated proinflammatory eicosanoid generationcould drive up other biomarkers of inflammation (eg, inter-leukin-6 [IL-6], tumor necrosis factor-! [TNF-!], and C-reac-

ABSTRACTThe majority of evidence suggests that n-6 polyunsaturated fatty acids, including lino-leic acid (LA), reduce the risk of cardiovascular disease as reflected by current dietaryrecommendations. However, concern has been expressed that a high intake of dietaryn-6 polyunsaturated fatty acid contributes to excess chronic inflammation, primarily byprompting the synthesis of proinflammatory eicosanoids derived from arachidonic acidand/or inhibiting the synthesis of anti-inflammatory eicosanoids fromeicosapentaenoicand/or docosahexaenoic acids. A systematic review of randomized controlled trials thatpermitted the assessment of dietary LA on biologic markers of chronic inflammationamong healthy noninfant populations was conducted to examine this concern. A searchof the English- and non–English-language literature usingMEDLINE, the Cochrane Con-trolled Trials Register, and EMBASE was conducted to identify relevant articles. Fifteenstudies (eight parallel and seven crossover) met inclusion criteria. None of the studiesreported significant findings for a wide variety of inflammatory markers, including C-reactive protein, fibrinogen, plasminogen activator inhibitor type 1, cytokines, solublevascular adhesion molecules, or tumor necrosis factor-!. The only significant outcomemeasures reported for higher LA intakes were greater excretion of prostaglandin E2 andlower excretion of 2,3-dinor-thromboxane B2 in one study and higher excretion of tet-ranorprostanedioic acid in another. However, the authors of those studies both observedthat these effects were not an indication of increased inflammation. We conclude thatvirtually no evidence is available from randomized, controlled intervention studiesamonghealthy, noninfant humanbeings to show that addition of LA to the diet increasesthe concentration of inflammatory markers.J Acad Nutr Diet. 2012;112:1029-1041.

ARTICLE INFORMATION

Article history:Accepted 23 March 2012

Keywords:Linoleic acidn-6 fatty acidsInflammationC-reactive protein

Copyright © 2012 by the Academy of Nutritionand Dietetics.2212-2672/$36.00doi: 10.1016/j.jand.2012.03.029

Meets Learning Need Codes 4000, 5000, 5160, 9000, and 9020. To take theContinuing Professional Education quiz for this article, log in towww.eatright.org, click the “MyProfile” link under your name at the top of thehomepage, select “Journal Quiz” from the menu on your myAcademy page,click “Journal Article Quiz” on the next page, and then click the “AdditionalJournal CPE Articles” button to view a list of available quizzes, from whichyou may select the quiz for this article.

RESEARCHReview

© 2012 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 1029

1394 pubblicazioni ! 15 lavori selezionati

Johnson GH et al, J Acad Nutr Diet, 2012

Omega-3, omega-6 and all-cause mortality

The Cardiovascular Health Study (2792 par0cipants aged ≥65 years, 8 y follow-‐up)

Wu JHY et al, Circulation 2014

Ferrucci L et al, J Clin Endocrinol Metab 2006

Plasma Polyunsaturated Fatty Acids and Circulating Inflammatory Markers in 1.123 free living subjects aged 20-98 (InCHIANTI study)

Dietary omega-6 and CHD Dose–response analysis for the curvilinear association between

dietary intake of linoleic acid and total coronary heart disease events.

Maryam S. Farvid et al. Circulation. 2014;130:1568-1578

Popolaz. Italiana

(INRAN, 2008) App. PUFA

totali

Donne Italiane (ibid)

Uomini Italiani (ibid)

Weight Watchers •  Successful life0me member (successful program completer)

•  Low-‐calorie, exchange diet; clients prepare own meals

•  “Get Moving” booklet distributed •  Behavioral weight control methods •  Group sessions, weekly mee0ngs

Method: Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started aoer 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 -‐ 61 years); median BMI 35.1 kg/m2 (IQR 31.8 -‐ 39.5 kg/m2 . Par0cipants received vouchers (funded by the PCT following referral by a healthcare professional) to ahend 12 WW mee0ngs. Body weight was measured at WW mee0ngs and relayed to the central database. Results: Median weight change for all referrals was -‐2.8 kg [IQR -‐5.9 -‐ -‐0.7 kg] represen0ng -‐3.1% ini0al weight. 33% of all courses resulted in loss of ≥5% ini0al weight. 54% of courses were completed. Median weight change for those comple0ng a first course was -‐5.4 kg [IQR -‐7.8 -‐ -‐3.1 kg] or -‐5.6% of ini0al weight. 57% lost ≥5% ini0al weight. Conclusions: A third of all pa0ents who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits.

Conclusion Each popular diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low, although increased adherence was associated with greater weight loss and cardiac risk factor reduc=ons for each diet group.

F Sacks et al. 2009;360:859-73.

3-‐6 months 1-‐2 years

Forest plot of low carbohydrate versus balanced diets in overweight and obese adults for weight loss (kg)

PLOS ONE 1 July 2014 | Volume 9 | Issue 7 | e100652

AHA Protein Criteria Atkins29 Zone30 Protein Power31 Sugar Busters32 S=llman28 Total protein is not excessive (average 50–100 g/d, propor0onal 15–20% kcal/day to carbohydrates and fat)

No. No. No. No. No.

1st 2 weeks = 125 g/d (36%) 127 g/d (34%) 91 g/d (26%) 71 g/d (27%) 162 g/d (64%)

Ongoing weight loss = 161 g/d (35%) Maintenance = 110 g/d (24%)

Carbohydrates are not omihed or severely restricted. Minimum of 100 g/d

No. Yes. No. Yes. No.

1st 2 weeks = 28 g/d (5%) 135 g/d (36%) 56 g/d (16%) 114 g/d (52%) 7 g/d (3%)

Ongoing weight loss = 33 g/d

Maintenance = Yes 128 g/d

Total fat (30%) and saturated fat (10%) are not excessive

No. Yes. No. Yes. No.

1st 2 weeks = 53% fat, 26% saturated fat per day

29% total calories, 4% saturated fat per day

54% total fat, 18% saturated fat per day



Total diet can be safely implemented over the long term by providing nutrient adequacy and support a healthful ea0ng plan to prevent increases in disease risk

No. No. No. No. No.

Limited food choices. Diet low in fiber, vitamin D, thiamine, pantothenic acid, copper, magnesium, manganese, potassium, calcium.*High in total fat and saturated fat

Food must be eaten in required propor0ons of protein, fat, carbohydrates. Menus not appealing, vegetable por0ons very large. Low in copper*

Not prac0cal for long term. Rigid rules. Diet low in calcium, fiber, pantothenic acid, copper, manganese.*High in total fat and saturated fat

Eliminates many carbohydrate foods. Discourages ea0ng fruit with meals. Low in calcium, vitamin D, vitamin E, pantothenic acid, copper, potassium*

Eliminates many foods. Diet low in fiber, vitamin A, thiamine, vitamin C, vitamin D, folate, pantothenic acid, calcium, copper, magnesium, manganese, potassium*

AHA Science Advisory, Circula0on 2001

Med Diet is as effec=ve as Low Carb diet in weight loss

T h e n e w e ngl a nd j o u r na l o f m e dic i n e

n engl j med 359;3 www.nejm.org july 17, 2008238

cant (P<0.05) only in the low-carbohydrate group (P = 0.45 for the comparison among groups).

Liver-Function TestsChanges in bilirubin, alkaline phosphatase, and alanine aminotransferase levels were similar among the diet groups. Alanine aminotransferase levels were significantly reduced from baseline to 24 months in the Mediterranean-diet and the low-carbohydrate groups (reductions of 3.4±11.0 and 2.6±8.6 units per liter, respectively; P<0.05 for the comparison with baseline in both groups).

Discussion

In this 2-year dietary-intervention study, we found that the Mediterranean and low-carbohydrate di-ets are effective alternatives to the low-fat diet for weight loss and appear to be just as safe as the low-fat diet. In addition to producing weight loss in this moderately obese group of participants, the low-carbohydrate and Mediterranean diets had some beneficial metabolic effects, a result sug-gesting that these dietary strategies might be con-sidered in clinical practice and that diets might be individualized according to personal preferences and metabolic needs. The similar caloric deficit achieved in all diet groups suggests that a low-car-

bohydrate, non–restricted-calorie diet may be opti-mal for those who will not follow a restricted-cal-orie dietary regimen. The increasing improvement in levels of some biomarkers over time up to the 24-month point, despite the achievement of maxi-mum weight loss by 6 months, suggests that a diet with a healthful composition has benefits be-yond weight reduction.

The present study has several limitations. We enrolled few women; however, we observed a sig-nificant interaction between the effects of diet group and sex on weight loss (women tended to lose more weight on the Mediterranean diet), and this difference between men and women was also reflected in the changes in leptin levels. This pos-sible sex-specific difference should be explored in further studies. The data from the few partici-pants with diabetes are of interest, but we recog-nize that measurement of HOMA-IR is not an op-timal method to assess insulin resistance among persons with diabetes. We relied on self-reported dietary intake, but we validated the dietary assess-ment in two different dietary-assessment tools and used electronic questionnaires to minimize the amount of missing data. Finally, one might argue that the unique nature of the workplace in this study, which permitted a closely monitored di-etary intervention for a period of 2 years, makes it difficult to generalize the results to other free-living populations. However, we believe that simi-lar strategies to maintain adherence could be ap-plied elsewhere.

The strengths of the study include the one-phase design, in which all participants started simultaneously; the relatively long duration of the study; the large study-group size; and the high rate of adherence. The monthly measurements of weight permitted a better understanding of the weight-loss trajectory than was the case in previ-ous studies.

We observed two phases of weight change: initial weight loss and weight maintenance. The maximum weight reduction was achieved during the first 6 months; this period was followed by the maintenance phase of partial rebound and a plateau. Among all diet groups, weight loss was greater for those who completed the 24-month study than for those who did not. Even moderate weight loss has health benefits, and our find-ings suggest benefits of behavioral approaches that yield weight losses similar to those obtained with pharmacotherapy.29

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P<0.001 for both comparisons with the low-fat diet

Figure 2. Weight Changes during 2 Years According to Diet Group.

Vertical bars indicate standard errors. To statistically evaluate the changes in weight measurements over time, generalized estimating equations were used, with the low-fat group as the reference group. The explanatory vari-ables were age, sex, time point, and diet group.

The New England Journal of Medicine Downloaded from nejm.org on September 8, 2014. For personal use only. No other uses without permission.

Copyright © 2008 Massachusetts Medical Society. All rights reserved.

Shai I et al, N Engl J Med 2008

F Sofi et al. Circula0on. 2018;137:00–00. DOI: 10.1161/CIRCULATIONAHA.117.030088

Common nutri0on inadequacies in GF-‐diet.

Detox diets •  Detox diets are marke0ng myth rather than nutri0onal reality. They sound like a great concept and it would be fabulous if they really delivered all that they promised! Unfortunately, many of the claims made by detox diet promoters are exaggerated, not based on robust science and any benefit short lived.

•  While they may encourage some posi0ve habits like ea0ng more fruit and vegetables, it’s best to enjoy a healthy, varied diet and ac0ve lifestyle rather than following a detox diet.

© BDA May 2014. Review date May 2016. Version 4.

The blood type diet •  Premise The foods you eat react chemically with your blood type. If you follow a diet designed for your blood type, your body will digest food more efficiently. You'll lose weight, have more energy, and help prevent disease.

•  Does It Work? •  What You Can Eat

Type O blood: A high-‐protein diet heavy on lean meat, poultry, fish, and vegetables, and light on grains, beans, and dairy. Type A blood: A meat-‐free diet based on fruits and vegetables, beans and legumes, and whole grains -‐-‐ ideally, organic and fresh Type B blood: Avoid corn, wheat, buckwheat, len0ls, tomatoes, peanuts, and sesame seeds. Chicken is also problema0c. Ea0ng green vegetables, eggs, certain meats, and low-‐fat dairy is encouraged. Type AB blood: Foods to focus on include tofu, seafood, dairy, and green vegetables. Avoid caffeine, alcohol, and smoked or cured meats.

•  Cons There haven't been any studies directly comparing weight loss and health in people who were on the diet against those who weren't. Only one study has evaluated this kind of diet. It found that people with certain blood types got more of a cholesterol-‐lowering benefit from ea0ng a low-‐fat diet.

modelli’alimentari’ -...

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